OUR SPECIALIST DEPARTMENTS
H2 breath test in Munich for suspected fructose or lactose intolerance
INTRODUCTION
Not only adults but also children may sometimes be unable to properly digest fructose or lactose. Unlike adults, however, children under the age of 10 often find it difficult to precisely describe or locate their symptoms. In addition, parents may perceive the problem very differently from their child. This is why it is important to rely on an objective test in order to make a reliable diagnosis. We are happy to perform a so-called H₂ breath test at our children’s clinic in Munich.
Advantages
Advantages of the H2 breath test at a glance
A safe and minimally burdensome test for suspected fructose or lactose intolerance
Proven and in use
since 1969
Gold standard for suspected fructose or lactose intolerance
Would you like to test your child for possible lactose intolerance? We are here for you!
Timing
When is an H2 breath test useful?
If children over the age of 10 experience repeatedly recurring abdominal pain, about half of the cases are due to lactose intolerance. In younger children, fructose intolerance is more common and typically presents with symptoms such as bloating and diarrhea. However, there are also other gastrointestinal issues that may indicate fructose or lactose intolerance.
For example:
- Nausea
- Constipation
- Vomiting (rare)
- Heartburn (rare)
- Dizziness (rare)
It is worthwhile to carry out a test if an intolerance is suspected. If, for example, fructose intolerance is present, the incompletely digested sugar components can, in the long term, damage the liver. However, this risk exists only if the affected children consume too much fructose.
Children who suffer from fructose intolerance sometimes also cannot tolerate sorbitol. This is a sugar alcohol that cannot be properly absorbed in the small intestine. Sorbitol intolerance can also occur in the context of glucose intolerance, where carbohydrate absorption is impaired. Whether lactose, glucose, fructose, or others: the breath test can also detect complex disorders caused by bacterial overgrowth.
How is the H2 breath test performed at our clinic in Munich?
The lactose test for children is completely painless and very easy to perform. It is the current gold standard for identifying lactose and fructose intolerances.
Depending on the case, your child receives a glass of water containing a fructose or lactose solution (300 ml), which must be consumed within a maximum of 5 minutes. Afterwards, at regular intervals of about every 15 to 30 minutes, your child breathes into a special device that measures hydrogen exhalation. Lactose and fructose are broken down by bacteria in the large intestine; the hydrogen produced is quickly absorbed into the bloodstream and then exhaled. If your child has an intolerance, the metabolism in the small intestine is impaired, causing more hydrogen to be produced in the large intestine. As soon as it is exhaled, we can measure it with our device. During the measurement, the child should remain seated and avoid excessive movement.
The entire test takes 2.5 to 3 hours. It’s best to bring your child’s favorite toys to prevent boredom. During the test, your child must not eat or drink anything. Of course, you may bring your child’s favorite snack as a reward, which they can enjoy after the test.
How reliable is the hydrogen breath test?
If the hydrogen level in the breath increases significantly, a diagnosis can be made when corresponding symptoms are present at the same time. However, there are also children with false-negative results: they test negative but still suffer from an intolerance with all typical symptoms. In some cases, the test may also be false-positive — for example, due to rapid small-intestinal transit. Therefore, it does not provide a 100% guarantee.
If necessary, we can perform a second test. In cases of suspected lactose intolerance, we administer small amounts of lactulose before the breath test — a complex carbohydrate that always produces hydrogen in the large intestine. Children who still do not show a positive H2 breath test in this situation are referred to as “non-producers” in medical terminology. They do not produce hydrogen even when the trigger is stronger.
An alternative is to eliminate lactose or fructose from the diet for two weeks. It is important to watch out for hidden lactose or fructose as well, which is why consultation at our clinic is advisable. This approach is also suitable for young children for whom the H2 breath test is not an option.
Experts
Our specialists for H2 breath testing in Munich
Schedule an appointment today with our experts at the M1 Private Clinic for Children & Adolescents!
Stefan Schlicht
Pediatric gastroenterologist & neonatology
Dr. Simon Mayer
Pediatrician & specialist in allergology
Dr. Reinhard Erdl
Pediatric allergist & specialist in asthma
Would you like your child to be tested for lactose intolerance or another intolerance in Munich? Our pediatric allergy specialists are here for you!
Testing for sugar intolerance: How to prepare your child
It is important to prepare well for the breath test if an intolerance is suspected. Otherwise, the measurements may be distorted and the test may have limited diagnostic value.
4 weeks before
Your child should no longer take antibiotics during this period. If they are unavoidable, the test must be postponed.
2 weeks before
No bowel cleansing should be performed during this period. If it is necessary, the examination should be postponed to another date.
5 days before
Proton pump inhibitors, probiotics, and medications that influence digestion or improve the absorption of other drugs should be discontinued. Plant-based bulking agents such as flaxseed and wheat bran should be avoided. If your child has diarrhea, please reschedule the appointment.
3 days before
Your child should consume less fruit, jam, honey, juices, spritzers, smoothies, fruit tea, sweets, milk, and dairy products. A low-fiber and low-residue diet is recommended. Avoid raw foods and particularly gas-producing foods (e.g., legumes such as beans, peas, lentils, corn, cabbage, onions, garlic, chives, etc.), as well as whole grain products.
Allowed foods include white bread and mixed or grey bread without whole grains, sausage, ham, lactose-free dairy products, meat and fish, pasta, white rice, potatoes, cooked or steamed vegetables, tofu or soy products, meat broths, leafy salads, and individual tomatoes or cucumbers. Unsweetened herbal tea and still water are also no problem.
On the morning of the examination
Your child must be completely fasting on the day of the examination: This means: no food, no milk, no juice, and no water! Please also refer to our H2 breath test guidelines.
Preparation for the H2 breath test
Please prepare your child appropriately for the examination. We have put together a document for this purpose, which you can easily download:
Here you can download the preparation instructions as a PDF and print them out if needed.
Advantages
Private Children’s hospital in Munich with a good atmosphere
Quick Appointment
We prioritize your child’s health, offering appointments within 3 days to ensure prompt care.
Short Waiting Times
Understanding the urgency, our Munich pediatricians ensure minimal waiting times.
Modern Equipment
Our Munich-based pediatricians have equipped the children’s hospital with the latest laboratory and diagnostic technology, ensuring precise and effective treatment. This includes advanced facilities like the 4D Motion Lab and a specialized allergy laboratory.
Interdisciplinary Team of Pediatricians
Our Munich hospital boasts 11 specialists from various fields, including leading pediatricians who collaborate as needed, directly benefiting your child’s healthcare.
We take our time
Our pediatricians in Munich give your child the attention they need and provide you with detailed information about diagnoses and therapies.
QUESTIONS & ANSWERS
Frequently asked questions about the H2 breath test in children
We are happy to assist you with further information and appointment scheduling. Book your appointment at our M1 Private Clinic. We will provide you with comprehensive advice regarding any questions about the H2 breath test for your child in Munich.
Our team is looking forward to seeing you!
How common is lactose intolerance worldwide?
Lactose intolerance is widespread globally, but there are significant differences depending on the region and population group. In Europe, about 5 to 15% of people are affected, with the prevalence being lowest in Northern Europe. In Africa and East Asia, however, 65 to over 90% of adults are lactose intolerant.
How common is lactose intolerance in children?
Lactose intolerance is very rare in children under the age of five. It usually develops during adolescence or adulthood. Worldwide, lactose intolerance is very common, although there are significant differences depending on the region and population group.
How is fructose intolerance tested in children?
An H2 breath test is the method of choice to determine fructose intolerance. If hereditary fructose intolerance is suspected in babies, a more complex DNA mutation analysis is recommended. We are happy to explain at our children’s clinic in Munich which test is appropriate for your child.
How does an H2 breath test work?
You should plan 2.5 to 3 hours for the test. After your child drinks water containing a certain amount of lactose or fructose, they blow into a device every 15 to 30 minutes, which measures the hydrogen level. Elevated concentrations indicate lactose or fructose intolerance.
When is an H2 breath test positive?
The hydrogen concentration is measured in ppm (parts per million). The test is considered positive if the H2 concentration rises more than 20 ppm above the baseline value measured at the very beginning. If the result is unclear, the test duration can be extended.
How does lactose intolerance present in children?
In children, lactose intolerance primarily presents with repeatedly recurring abdominal pain. Bloating, a feeling of fullness, diarrhea, and abdominal cramps may also occur. In addition, the symptoms can resemble those of a cow’s milk allergy, although the latter often causes more severe reactions (such as hives, breathing difficulties, vomiting, or a drop in blood pressure).
Does the test carry any risks?
After the breath test for suspected lactose intolerance or other intolerances, bloating or diarrhea may occur. However, these symptoms are harmless and usually disappear on their own very quickly.
Is lactose intolerance hereditary?
Yes, lactose intolerance can be genetically determined. The predisposition to lactose intolerance is often inherited and is more common in populations that traditionally consume few dairy products.
What alternatives are available for people with lactose intolerance?
For people with lactose intolerance, there are numerous alternatives to conventional dairy products, such as lactose-free milk, plant-based milk varieties (e.g., soy, almond, or oat milk), and specially produced lactose-free products.
Can lactose intolerance be treated?
There is no cure for lactose intolerance, but symptoms can be managed by avoiding lactose-containing foods and using lactase supplements.
Sources: Institute for Quality and Efficiency in Health Care (IQWiG)
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